Evidence Based Practice

Dorothea Orem’s Self Care Deficit Theory

Self Care Deficit Theory
 Theory Overview

 The question “What is the condition that

indicates that a person needs nursing
care?” was the basis of the Self Care Deficit
Theory.
 Theory focuses on what a person requires
and what actions need to be taken to meet
those requirements (Alligood & Tomey,
2010, p. 278)
 Theory includes Universal Self-Care
Requisites- needs all people have and
Power Components- influences on a
persons ability to perform self care
(Nunnery, 2008, p. 59)
Self Care Deficit Theory
 Rationale for Nursing Theory

 Clear and concise theory allows

nurses to assess patients’ ability
to care for themselves.

 Increasing healthcare costs

result in more patients being
cared for at home.

 Patients expected to take more

responsibility for self-care sooner
because of decreased length of
hospital stays.
Self Care Deficit Theory

 Relevance for Practice

 Individuals strive to meet their own

healthcare needs; people do not want to
be dependent on others.
 Nursing care is focused on helping
people to meet their own, and their
dependent others’, self care demands
(Nunnery, 2008, p. 60).
 Pertains to all areas of nursing.
 Provides a unique focus on nursing that
can be applied to other fields.
Research Studies
 Conducted in many areas of nursing
including:
 Hemodialysis
 Patient perceptions of home dialysis and self
care.
 Heart Failure
 Supportive educative program for advanced
heart failure patients and quality of life in
heart failure patients.
 Pediatric Oncology
 Self-care operations and nursing
interventions for pediatric oncology patients.
 Home Care/Caregiver Strain
 Relationship between self-care and caregiver
strain by female caregivers
 Learning Disabilities
 Self care deficit theory applied to people with
learning disabilities.
Research Review

Hemodialysis
 Journal article from Canadian
Association of Nephrology Nurses and
Technologist Journal entitled
“Hemodialysis patient’s perceptions of
home hemodialysis and self-care”
(Visaya, 2010, p. 23-28).
 Research study conducted to
determine if dialysis patients are
capable of doing home hemodialysis
care.
Research Review

Hemodialysis

 Research Approach
 Qualitative study done using Orem’s Theory of
Self-Care.
 Conducted at a hemodialysis unit in Ontario,
Canada.
 Research participants were required to be over
18 years of age, alert and oriented, able to read
and write English, and have visual acuity to
perform tasks. Total participants were 49.
 Participants were given a survey and
assessment tool to assess their perceptions on
home dialysis and their ability to do self-care.
Research Review
Hemodialysis

 Research Findings

 To be capable of performing home hemodialysis,

according to Orem’s theory patients must first be
able to do activities of “human functioning,
human well being and the development within
social groups” (Visaya, 2010, p. 27).
 24.5 % of participants scored “good” in human
functioning.
 61.2 % of patients scored “good” in managing
self-care.
 57.1% of patients scored “good” in social
support (development within social groups)
Results 83.7 % of participants would NOT be able
to perform self-care and home hemodialysis
Research Review

Hemodialysis

 Research Critique:

 Study was conducted only on newly diagnosed

end-stage renal failure patients who were
starting hemodialysis. A more accurate sample
would have also included patients already on
hemodialysis.
 Relatively small sample comprised of only 49
participants.
Research Review

Hemodialysis

 Implications for Practice:

 Orem’s Self-Care Theory can be used to

screen patients for self-care at home in
many areas of nursing, not just
hemodialysis.
 Pre-screening patients to determine ability
for self-care can help determine if they are
ready to go home or will need rehabilitation
and continuing care first.
Research Review
Heart Failure (Study 1)

 Journal article from Nursing Science

Quarterly entitled “Developing a supportive
educative program for patients with
advanced heart failure within Orem’s general
theory of nursing” (Jaarsma et. al., 1998, p.
79-85).
 Research study of heart failure patients and
how the use of Orem’s Universal Self-Care
Requisites can identify educational needs
and self-care deficits.
Research Review
Heart Failure (Study 1)

 Research Approach:

 Supportive educative nursing program was

designed for heart failure patients.
 To help nurses assess patients possible
limitations in knowing, judgment/decision-
making, and actions a checklist of questions
was formulated based on theoretical self-
care demands and required self-care agents.
 Based on the responses to the checklist
questions nurses are able to determine the
amount of supportive educative education
the patient needs.
 Sixty patients were in a control group that
did NOT receive the education, sixty were in
the experimental group that did.
Research Review

Heart Failure (Study 1)

 Research Findings:

 60 patients were placed into a control group

where they did NOT receive supportive
education from a nurse.
 60 patients were placed in an experimental
group where they DID receive supportive
education from a nurse.
 Evaluation of outcomes was determined by
data collected on self-care agency, self-care,
hospital readmission, and quality of life
before intervention (supportive education)
and 1, 3, and 9 months after intervention
(Jaarsma et al., 1998, p. 84).
Research Review

Heart Failure (Study 1)

 Research Critique

 Focus of the research study was on the

patient only and did not include the
family as a whole.
 Study did not take into account other
diseases/illnesses that the patient may
have and how those would further affect
their ability to perform self-care.
Research Review

Heart Failure (Study 1)

 Implications for Practice:

 Careful assessment of all of the potential

self-care demands a patient will have is
important as well as who will perform the
demands (self-care agent).
 Nurses need to assess a patients perception
of their ability to perform the self-care
demands.
 Nurses need to continue to improve upon
the education heart failure patients receive.
 Similar tools as the one used in the study
could be developed for many disease such
as renal failure and COPD.
Research Review
Heart Failure (Study 2)

 Journal article from the Journal of the American

Academy of Nurse Practitioners entitled “Self-care
and quality of life among patients with heart
failure” (Britz & Dunn, 2010, p. 480-487).
 Patients admitted with acute, chronic congestive
heart failure were asked to complete the Self-care
of Heart Failure Index and the Minnesota Living
with Heart Failure questionnaires. This information
was then used to determine if there was a
relationship between self-care abilities and quality
of life.
Research Review
Heart Failure (Study 2)

 Research Approach:

 Self-care of the heart failure patients was measured

using the Self-Care of Heart Failure Index (SCHFI)
scale.
 Quality of life was assessed using the Minnesota
Living with Heart Failure (MLHF) questionnaire.
 Participants were comprised of a convenience
sample at a Midwestern hospital. All patients had
an admitting diagnosis of heart failure, were over 18
years of age, and were able to read, write, and
understand English.
 Patients who were NOT considered included those
with new onset or acute/transient heart failure and
those coming from a long-term care facility where
most if not all of their self-care needs were met by
healthcare providers.
Research Review

Heart Failure (Study 2)

 Research Findings:

 Thirty subjects completed the study.

 Fifty percent of participants reported their
general health as “poor”.
 Patient reported self-care included: Using a
pill system, checking their ankles for swelling,
daily weighing, and doctor visits.
 Patients felt that their heart failure had very
little effect on family burden, loss of control,
and making them feel worried and depressed
(Britz & Dunn, 2010, p. 482).
Results: Self-care confidence was significantly
related to quality of life.
Research Review

Heart Failure (Study 2)

 Research Critique:

 Small sample population

 Patients were all from one Midwestern

hospital; limited geographical range.

 Cross-sectional study preventing knowledge of

self-care abilities over time.
Research Review

Heart Failure (Study 2)

 Implications for Practice:

 Better education for patients and family

members regarding heart failure symptoms
and dietary requirements.
 Nurses should ensure that patients and
families understand the disease process so
they are more likely to follow recommended
treatment (diet, medications, etc…)
Research Review

Pediatric Oncology

 Research article from Nursing Science Quarterly

entitled “Self-care operations and nursing
interventions for children with caner and their
parents” (Moore & Beckwitt, 2006, p. 147-156)

 Research study focusing on determining what

self-care and dependent-care actions the
children and their parents performed and their
perceptions of nursing interventions that
promoted and supported their actions.
Research Review

Pediatric Oncology

 Research Approach:

 Qualitative study based on Orem’s theory of

self-care.
 Sample population of 27; 9 children and 18
parents.
 Children involved in the study had received
care at 11 different institutions in 7 states.
 Study was comprised of interviews about self-
care with children participants and
dependent-care with parent participants.
 Data was obtained about perceived
supportive nursing interventions.
Research Review
Pediatric Oncology

 Research Findings:

 Overall patients and families felt that

nurses did well at teaching, supplying
information and supporting self-care
actions.
 Nurses could improve on involving siblings
in dependent-care, emotional support,
celebrating recovery, and referring
patients and families to support groups,
social workers, and mental healthcare
professionals.
Research Review

Pediatric Oncology

 Research Critique:

 Wide range in patient ages (7 to 21 years).

 Limited racial/ethnic group.

 Few male parents included in study.

 Small sample population.

 The research study did undergo the peer review

process, which gives it credibility.
Research Review

Pediatric Oncology

 Implications for Practice:

 It is important to assess all possible

caregivers (including siblings)
 Emotional and spiritual support are important
to patients just as being taken care of
physically is.
 Many patients and families felt the nurses
should have provided a referral to a support
group.
Research Review
Home Care

 Journal article from the Journal of the New York

State Nurses Association entitled “The
relationships of self-care agency and self-care
to caregiver strain as perceived by female
family caregivers of elderly parents (Baker,
1997, p. 7-11).
 Research study examining the relationships of
self-care agency (potential or capacity of
individuals to meet their own needs) and self-
care actions to perceived caregiver strain
among female family caregivers of elderly
parents (Baker, 1997, p. 1).
Research Review
Home Care

 Research Approach:

 Study based on Orem’s 1991 conceptual model.

 Perception of caregiver strain as a self-care deficit;
an imbalance between the caregiver’s capability to
meet her own needs (Baker, 1997, p. 3)
 Participants were solicited from a certified home
health agency in a large metropolitan city.
 131 participants satisfied study requirements; all
were heavily involved with caregiving tasks such as
personal care, household tasks, personal
management tasks, and emotional support.
 Participants received a questionnaire booklet
containing: The Burden Interview, the Denyes
Self-Care Agency, the Denyes Self-Care Practice
Instrument, and a demographic sheet.
Research Review

Home Health

 Research Findings:

 Length of time as a caregiver, quantity of

multiple roles of caregiver, and types of
caregiving tasks were examined (Baker, 1997,
p. 3)
 Self-care actions was determined to be the
single significant contributor to the variance of
caregiver strain.
 Self-care agency (potential to do actions) was
related to, but not predictive of a decrease in
caregiver strain.
Results: There is a notable change in self-care
deficit (caregiver strain) in the presence of self-
care actions Baker, 1997, p. 6).
Research Review

Home Health

 Research Critique:

 Study did not take into account if the person

was the sole familial caregiver.
 No consideration of the caregivers support
system.
 Relatively small sample population all from one
geographical location.
 All participants were selected from the same
certified home health agency.
Research Review

Home Care

 Implications for Practice:

 It is important to assess what help a patient

will have available and who will provide that
help.
 If a family member will be the main
caregiver it is important to educate that
person on the importance of self-care.
 Make referrals to care management or social
work to develop a plan of who will care for
the patient at home.
 Assess the support system that the caregiver
has; do they have a spouse who will help
support them?
Research Review

Learning Disabilities

 Research article from the journal Learning Disability

Practice entitled “Exploring Orem’s self-care deficit
nursing theory in learning disability” (Horan, Doran,
Timmins, 2004, p. 28-33).

 Examines the ability of Orem’s self-care model to

meet the needs of people with varying degrees of
intellectual disabilities and additional physical care
needs (Horan et al, 2004, p. 1)
Research Review

Learning Disabilities

 Research Approach:
Research Review

Learning Disabilities

 Research Critique:
Research Review

Learning Disabilities

 Implications for Practice:

Critical Reflections
 Through research theories are tested and improved
upon.
 Nursing research helps to improve the nursing
profession; we learn how to take better care of our
patients and they can help to take care of themselves.
 Research is needed to know what nursing practices are
functional before putting them into use.
 Research, theory, and nursing practice are all
interrelated.
 Theory creates the framework for research, research
findings guide our practice, and our practice directs our
theories and research.
 Research helps us to understand what areas we do well
in and what we as nurses can improve upon.
 Research shows us that patient education is an
important aspect of nursing because it helps patients to
take better care of themselves and prevent relapse and
hospitalization.
References
Baker, S. (1997). The relationships of self-care agency
and self-care to caregiver strain as perceived by
female family caregivers of elderly parents.
Journal of the New York State Nurses Association,
28(1), 7-11. Retrieved from CINAHL database.

Britz, J., & Dunn, K. (2010). Self-care and quality of life

among patients with heart failure. Journal of the
American Academy of Nurse Practitioners, 22(9),
480-487. Retrieved from CINAHL database.

Jaarsma, T., Halfens, R., Senten, M., Abu Saad, H., &
Dracup, K. (1998). Developing a supportive
educative program for patients with advanced
heart failure within Orem’s general theory of
nursing. Nursing Science Quarterly, 11(3), 79-85.
Doi: 10.1177/089431849801100210
References
Moore, J.B., Beckwitt, A.E., (2006). Self-care operations
and nursing interventions for children with cancer
and their parents. Nursing Science Quarterly, 2,
149-156. doi: 10.1177/0894318406286594

Visaya, M.A., (2010). Hemodialysis patients’ perceptions

of home hemodialysis and self-care. Canadian
Association of Nephrology Nurses and
Technologist Journal, 20(2), 23-28. Retrieved
from CINAHL database.